Assess Tobacco Use Research Articles

A Clinical Practice Guideline for Treating Tobacco Use and Dependence: A US Public Health Service Report

ObjectiveTo summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive clinical interventions, and system changes to promote the treatment of tobacco dependence.ParticipantsAn independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Quality. A consortium of 7 governmental and nonprofit organizations sponsored the update.EvidenceApproximately 6000 English-language, peer-reviewed articles and abstracts, published between 1975 and 1999, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses.Consensus ProcessOne panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised.ConclusionsThis evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved. (2) Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must institutionalize the consistent identification, documentation, and treatment of every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief treatment. (5) There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective—practical counseling, social support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence—sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch—are effective, and at least 1 of these medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the updated guideline.

Smoking among Male Psychiatric Outpatients in Saudi Arabia

The prevalence rate of smoking among psychiatric patients has been shown to be higher than that among the general population, and this may have several neuropsychiatric implications. This cross-sectional study examines the prevalence, sociodemographic variables and pattern of smoking among psychiatric outpatients in Saudi Arabia. Over a period of 18 months (January 1996 to June 1997), 505 outpatients from five different hospitals were randomly selected to participate in the study. It was observed that 292 patients (57.83%) were current smokers, 199 (39.4%) were nonsmokers and 14 patients (2.77%) were ex-smokers. Besides revealing certain attitudes towards smoking and religious antismoking notions, it was observed that unemployment, low education status, rural background, and drug abuse were significantly associated with smoking. The prevalence rate of smoking revealed in this study is consistent with international data, and probably has implications similar to those reported in other studies. This study also found certain patterns of tobacco use in psychiatric outpatients characterized by certain sociodemographic variables and drug abuse.

Alcohol and smoking history on admission to a psychiatric hospital

This is a retrospective study of 173 consecutive admissions to a general psychiatric hospital. The aim was to establish the frequency and adequacy with which alcohol and tobacco use were recorded. Regarding alcohol, in 41% of the notes there was no adequate quantitative history, in 29.5% there was a descriptive mention and in 29.5% no history was recorded. Female patients were less likely to have an alcohol history taken than male patients. With tobacco, in 64% of the notes there was an adequate quantitative history, in 6.4% there was a descriptive comment and in 28.9% no history was recorded. It is to be stressed to all doctors that an assessment of alcohol and tobacco use should be made for every patient, whatever their age, gender or ethnic origin.

Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions.

The current status of tobacco use among young cancer patients and the acute and chronic complications associated with tobacco use in these patients is reviewed. Studies report that adolescent cancer survivors use tobacco as much as their peers who have never been treated for cancer, despite the adverse consequences of engaging in this unhealthy habit. Health care professionals have the opportunity and responsibility to incorporate tobacco counseling as a routine component of medical care delivery. Nurse/physician-delivered smoking interventions have been found to promote smoking cessation in adults, although little effort has been devoted to the development of similarly effective smoking interventions for pediatric cancer patients who smoke. Components of existing smoking prevention/cessation curricula from successful school-based interventions and physician-delivered smoking interventions can be adapted and tailored to pediatric cancer patients in medical settings. Smoking interventions that educate patients about their increased vulnerability to tobacco-related consequences, relative to their healthy peers, may have an enhanced impact. Guidelines for conducting a comprehensive assessment of tobacco use and implementing smoking interventions with pediatric cancer patients is provided. Strategies for modifying the cancer patient's perceived vulnerability to tobacco-related consequences is also discussed.

Assessment of alcohol and tobacco use in dental schools' health history forms

Health history forms are an integral component of students' clinical and didactic training in physical assessment and often serve as a model for students to use in their future practices. This study examined how alcohol and tobacco use are assessed in patient health history forms used in the dental schools of the United States and Canada (n = 63). Deans of schools were requested to send a copy of their health history and other supplemental forms used for patient care. The response rate was 98 percent. Almost 25 percent of the schools' forms did not address either alcohol or tobacco use; 37 percent failed to address one or both risk behaviors; 25 percent did not request tobacco information; and 36 percent did not address alcohol use. Major inconsistencies regarding the inclusion, content, and quantity of alcohol and tobacco questions were noted. Consensus among dental schools as to which questions to include in their health forms was not apparent.

Using a low-cost, prize-drawing incentive to improve recruitment rate at a work-site smoking cessation clinic.

A major obstacle in promoting smoking cessation programs through work sites is recruiting adequate numbers of smokers. We used a quasi-experimental design to evaluate the effect of a low-cost incentive (a prize drawing) for attracting participants to a smoking cessation clinic offered at multiple work sites. Sixty-eight automobile dealerships were randomized to either a "prize" or control group. Smokers employed at work sites in the prize group were offered a chance to win a dinner for two for participating in a smoking cessation clinic. In November 1986, a questionnaire assessing tobacco use habits was sent to 3432 employees of the 68 work sites. A cohort of 844 smokers was identified from a total of 1986 employees who returned surveys. All smokers received registration materials to participate, free of charge, in one of three smoking cessation programs held in June 1987. The overall employee participation rate in the smoking cessation program was 6.6% (n = 56) with an overall work-site participation rate of 37.3% (n = 25). The rate was nearly identical in the "prize" and control groups (employee rate: 6.3% versus 6.7%; work-site rate: 39.4% versus 35.3%, respectively).

Factors Associated With Slow Progression in Huntington's Disease

The rate of disease progression was assessed for 42 persons affected by Huntington's disease who had been neurologically examined at least six times and followed up for at least 3 years. Disease progression was assessed by a disability rating scale administered at each examination. Slow progression was associated with older age at onset of disease and with heavier weight (body mass index) at the first examination. Men tended to have a slower disease progression than did women, and this was particularly evident among men inheriting Huntington's disease from affected mothers. Neither the butyrophenone haloperidol nor the tricyclic antidepressant imipramine were related to rate of progression. Assessments of depression, hostility, and tobacco use were also unrelated to rate of progression. Clinical trials in Huntington's disease should consider these factors when designing therapeutic studies.

Does the computer make a difference? Computerized versus face-to-face versus self-report assessment of alcohol, drug, and tobacco use.

Does the computer make a difference? Computerized versus face-to-face versus self-report assessment of alcohol, drug, and tobacco use.